Provider Demographics
NPI:1780225037
Name:CHISHOLM, EDNA HODGE
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:HODGE
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 STONEY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1233
Mailing Address - Country:US
Mailing Address - Phone:434-770-1354
Mailing Address - Fax:276-336-3898
Practice Address - Street 1:2180 STONEY MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1233
Practice Address - Country:US
Practice Address - Phone:434-770-1354
Practice Address - Fax:276-336-3898
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle